The Orchestration of Joy and Suffering

Sound Bite

In the heart-wrenching world of chronic addiction and relapse, root causes of problematic behavior may be camouflaged, punished, praised, or often tragically ignored until the behavior is so firmly entrenched neurologically that it becomes powerfully resistant to treatment and rehabilitation efforts. In an elegant presentation, addiction therapist Corinne Gerwe explores the link between intense childhood experiences, persistent behaviors, and chronic addiction, and outlines a novel treatment methodology. Through poignant personal stories, Gerwe shows how extreme experiences in childhood can trigger behaviors that may change the course of people's lives ' creating superstars in the best cases, chronic addicts and criminals in the worst.

About the Book

Is it possible that an extraordinary experience in our childhood can change the course of a person's life? Can such "singular episodes" (or a series of episodic experiences) have as much significance in childhood development as hereditary and environmental influences? The author believes that the answer to these questions is yes. Her theory was born out of the course of her own life and her work in the field of substance abuse treatment. Her professional experience provided a forum for investigation, research and development of the High Risk Identification and Prediction Treatment Method (HRIPTM). The HRIPTM explores the link between conditions arising from childhood experiences, behaviors that persist, and the development of chronic addiction and other disorder conditions. The book brings together individuals under treatment as well as such historical figures as Conan Doyle, Charles Darwin, Kafka, Beethoven, Houdini, and Robert Louis Stevenson. They demonstrate the common bond of behavior that affects us all, illustrating how this behavior can be camouflaged, disguised, hidden, misunderstood, ineffectively punished or very effectively praised, and often tragically unaddressed until it is so firmly entrenched neurologically that it becomes powerfully resistant to treatment and rehabilitation efforts. The case histories of notable figures were gathered from literary diaries and letters, literature and poetic texts, autobiographies biographies and media interviews. The clinical case summaries concluding each chapter are taken from the HRIPTM research. Collectively, they provide a fascinating account of how an intricate and far-reaching web of problematic behavior can originate and evolve.

Introduction

A BEGINNING OVERTURE: PIVOTAL CHILDHOOD EXPERIENCE In recent years, scientific breakthroughs in mind/brain research have revolutionized theories on childhood development. Although the Nature vs. Nurture debate continues, it is now recognized that each child is born with a unique biology that greatly influences, but does not predetermine, life course. The expression or influence of the genes depends on interactions with those in the cell, the body, and in the social and physical world of the child.2 Early childhood is the most crucial and the most vulnerable time in how a child develops, emotionally and intellectually. During the first two years of life, a child learns to regulate feelings and behavior through reciprocal interactions with the parents or caregiver. This vitally important relationship provides the nurturing and protection that is essential to a child's level of security. Within the boundaries of this relationship, a child learns to perceive and respond to emotional cues, develop empathy and form a sense of self. As the child develops the ability to regulate emotions within the framework of a secure environment (one that provides consistent care and guidance), difficult experiences that present challenges can be negotiated with increasing success and autonomy. A child's neuronal development is not only shaped by experiences, but by how a child responds to his or her experiences. Early experiences affect children's later ability to learn and reason.3 When a child does not learn to regulate emotions, or if an experience occurs that propels a child into an emotional realm that is beyond his or her ability to regulate, a behavioral dynamic can be spontaneously constructed to help the child compensate during and after the de-regulating experience. Pivotal experiences are those that result in a distinct change in behavior that alters the child's development and life course to some degree. This work is an effort to shed light on the origin and development of problematic behavior that arises from a unique level of childhood experience. Although childhood trauma and abuse are, of course, highly represented here in relation to this pivotal phenomenon, a much wider range of childhood experience is brought into view to demonstrate the individual nature of a pivotal experience. The conditions and common factors that link certain experiences to behavior that is characterized by repetition, obsessive/compulsive thought and action, and behavior pattern development that insidiously evolves from childhood into adulthood, are presented with clear theoretical explanation and interesting clinical and notable case examples. Two primary dimensions will be explored in relation to these conditions and common factors: $'¢ experiences that generate an extreme distress state of Suffering, and $'¢ experiences that generate an extreme arousal state of Joy. For the purpose of clarity, the terms Suffering and Joy were chosen to represent the two extremes of a spectrum of emotional and physiological states generated by pivotal childhood experience. These states are comprised of a variety of feeling and physical symptom combinations that are unique to each individual. The role of pivotal experience, experience that propels a child into a highly intense-to-extreme dimension of joy or suffering, will be explored in depth in relation to the origin of behavior that sabotages healthy childhood development and creates vulnerability to addiction and many other psychological disorders. Pivotal childhood experience is one of the most underestimated areas of concern in relation to prevention and treatment of these conditions. Behaviors that develop into repetitive and/or obsessive patterns can be linked to a dynamic that occurs during experiences that produce in the child a highly intense-to-extreme emotional state. As feelings occur in response to an experience, the most forceful feature is the set of physical symptoms that is also generated. When feelings and physical symptoms begin to escalate to an extreme level of intensity, the child can experience an emotional state and physiological condition that become overwhelming. Examples of feelings reported during this state include: anger, fear, frustration, terror, excitement, embarrassment, rage, sadness, loneliness, desperation, jealousy, and many others. Examples of physical symptoms reported include: '¢ Visual and hearing distortion or impairment, difficulty breathing, difficulty swallowing, vocal impairment. '¢ Changes in body temperature. Loss of body fluids, through tears, urine, vomit, perspiration, bowel movement. Changes in heart rate. Changes in energy level. Stomach distress. Involuntary body movement (shaking, trembling, twitching). '¢ Changes in skin, such as rashes, flushing, red patches, hives. $'¢ Increased mental activity. Descriptions include mental confusion, racing mind, diminished ability to think clearly, diminished ability to think rationally, pressure or pounding in various regions of the head and face. When a child has an experience that produces a combination of feelings and physical symptoms that increase in intensity toward an extreme level, the behavioral action that effectively works to decrease or alter the distress level to some degree will be registered in the brain and in memory as an effective response for distress-symptom relief. The peak level of an experience of this nature is recorded in such a way that, years later, certain details of the experience can be vividly recalled whenever the episode surfaces in memory. Experiences that produce in the child an extreme state of suffering are often later described as intolerable or unbearable at the point when the behavior takes place. If another experience, or a series of experiences, triggers the feeling and physical symptom combination generated during the initial experience, the associated behavior, which has now become an integral part of the combination, will be repeated'¦. I have thought so many times, listening to addiction relapse patients, how tragic it was that nothing was done for them at the beginning. And even though I have designed a method for addressing the complex conditions that later surface, they are very difficult to treat. I have therefore concluded many of the chapters with examples that illustrate the depth of the problem. In many respects, the only true prevention can and must be done in the early stages. The HRIPTM (High Risk Identification and Prediction Treatment Method) brings forth crucial information that supports the need for early childhood interventions at every level of development. And the most important thing about this is that parents need to be much more aware that the seeds of later problematic conditions can be created during experiences that are characterized by the dynamics described in this text. Once created, the seeds are germinated by the behavioral response that occurs and they grow from behavioral repetition that is often overlooked by all those who surround the child. This is everyone's problem. Many of the problematic behavioral patterns that lead to obsession do not necessarily lead to addiction, but do lead to life-sabotaging actions that overpower the individual. Addiction is just one of the most likely outcomes for many of these people. In today's approach to addiction treatment, shortcut methods addressing here-and-now solution-focused outcomes don't even put a dent in the chronic potential of these people. This is a society problem and the current youth population is exposed to an increasing amount of insecurity and dangerous stimuli that produce the right conditions for these types of experiences. Intervention programs designed to help troubled and/or delinquent children are expanding, but their waiting lists are very long, and getting longer. The mental health issues of the young people they accept are getting more complex. The increase in reliance on prescribed medications is astounding, and the abuse and neglect issues reported are appalling. And these boys and girls are not just from poor families; the private-pay clients come from some of the wealthiest. It is an across-the board-problem. If society continues to depend on later treatment, instead of early prevention, the cost will continue to grow ' unnecessarily. What is the HRIPTM? The High Risk Identification and Prediction Treatment Model (HRIPTM) was developed to increase patient and clinician ability to identify, assess and treat chronic behavioral and addiction risk symptoms more effectively. The HRIPTM was developed over many years of work with chronic patients and criminal offenders within a wide range of addiction treatment and rehabilitation settings, including military, corrections and hospital-based facilities. The primary focus of this method is to unearth information that otherwise would not be revealed, and therefore could not be addressed by whatever treatment approach the individual finds. When core issues remain buried and the individual cannot personally identify, or even understand, what events are important to share or reveal, the most crucial information is often lost in superficial disclosure and mimicking of other patients or clients involved in the treatment process. Therefore, the following chapters focus more on the unearthing process, and what comes forth, than on the treatment approach that is prescribed based on these revelations. The cases chosen as examples for this book represent people who have been in treatment multiple times and who, in most cases, never previously revealed what came forth until they participated in the Orchestration Group Process. When you realize that, then you can see why, for years, I worked on developing a way to identify and expose underlying developmental issues. I knew, from my experience listening to the most chronic patients and offenders, that such issues were creating havoc in their lives and disrupting their recovery processes. The HRIPTM was developed with a consistent and dedicated approach to addressing the chronic nature of addiction and its underlying problems. This method has recently been incorporated into a pilot project in Atlanta for the Georgia State Department of Corrections, Pardons and Parole. From the beginning of my professional career as a counselor assigned to develop relapse prevention programming, to my work today, I have consistently accumulated data that support the link between the developmental period and chronic behavioral and addiction conditions. The HRIPTM methods were designed to investigate the developmental process of each individual, to determine the origin and nature of lifesabotaging patterns of behavior characterized by obsessive/compulsive repetition. In practice, HRIPTM is a highly-structured approach built around the Orchestration Group Process (OGP), in which I used the musical concept as a model to facilitate investigation of the individual within a dynamic, organized and collective process. The Orchestration Group Process (OGP) is a structured format in which one member of the treatment group, in the role of 'group focus,' shares (describes out loud) one pivotal experience. The session is structured to represent what occurs during an experience. The group facilitator is the conductor, and leads the person who is sharing through the process of identifying what is being recalled in the vivid center of detail that arises in memory. The other group members sit in a semi-circle of rows, set up like an orchestra around the person who is disclosing his or her experience. The first row represents the feeling/physical symptom response; group participants share how each of them might have felt and physically responded if the experience being shared had happened to them. The second row represents the behavioral response; each participant shares how he or she might have behaved in such a situation. The person who is sharing as 'focus' listens to each disclosure from the others and gains increased insight into his or her own experience, as the others respond by identifying their most powerful feeling, physical symptoms and behavioral responses. The facilitator (conductor) gains vital information about each member of the group during this highly structured process. The case studies that conclude each of the following chapters represent the information that comes to light during the Orchestration Group Process ' crucial information for the patient and his counselors, crucial information that previous treatment processes failed to reveal. Assessment questionnaires and other materials were developed from the OGP to enhance its effectiveness. The HRIPTM Manual, for patients in the program, includes written exercises, charts and other materials designed to educate the patient about the nature and condition of chronic behavioral and addiction relapse and to pinpoint the sabotaging elements that are individual to each case. This collaborative approach to individualized treatment enables the clinician and patient to address together the psychological and physiological dynamics stemming from pre-addiction factors, while recognizing the importance of all other aspects of treatment that address the onset and process of addiction and post-addiction factors. A study conducted to determine the effectiveness of the HRIPTM was published in 2001 in the February issue Journal of Substance Abuse Treatment. The Orchestration of Joy and Suffering was written to help parents, teachers, friends and neighbors to understand problematic conditions that can arise from certain childhood experiences. More importantly, it was from the voices and revelations of those who suffer these conditions to the most chronic degree that this evidence emerged. Corinne F. Gerwe, PhD (Biological Psychology), CCAS (Certified Clinical Addiction Specialist), CAS (National Certification) American Academy of Health Care Providers in the Addictive Disorders (AAHCPAD)